For anyone to die from a disease that medical professionals can prevent is horrifying, says Dr. Dionne Dames-Rahming. That is why this internal medicine specialist touts the importance of vaccination to prevent diseases, protect and preserve life, despite the controversies over immunization. With some people refusing to vaccinate their children because of perceived problems, Dr. Dames-Rahming said that vaccines are relatively safe, and that there is no significant evidence to say otherwise.

Speaking at the most recent Doctors Hospital Distinguished Lecture Series Dr. Dames-Rahming, who spoke on the history of vaccination, the purpose for vaccination and the controversies that exist in vaccinations said even though vaccination is not 100 percent effective, and that not all individuals are capable of being vaccinated it is still important, as vaccinating can help protect individuals at risk.

“Vaccination is administering a vaccine which can be composed of a modified organism, a weakened organism, a killed organism [or] a part of an organism. The whole purpose of giving the vaccine is to help your immune system to generate a response so that it prevents you from actually developing a disease. The prevention part, or getting your body to respond is for you to have immunity and that is immunization, so they kind of go hand-in-hand. We vaccinate in hope of making a patient immune to develop a disease process,” said Dr. Dames-Rahming.

The doctor said the vaccine is supposed to stimulate the development of antibodies which are programmed so that when the organism gets exposed to a real organism that can cause disease, the antibodies are there to prevent disease from developing.

“When we give a vaccine, there are specialized cells within the body known as antigen-presenting cells, and basically what they do is take in that protein or that organism, break it down into pieces, and those pieces are presented to our immune system, which is like soldiers or the policemen, and they are there to protect us.”

With vaccines doctors expect the natural killer cells in a person’s body to be activated so that any infected cell would be destroyed. Dr. Dames-Rahming said when doctors initially administer the vaccine, they expect a person’s body to remember so that when a real living organism presents itself the body remembers and can act quickly, and stop the disease from developing. However, that doesn’t happen all the time.

“I would be lying if I said if we vaccinate everybody nobody would get ill. But that’s just not how it works. Everybody’s immune system may be a little bit different. For a lot of the vaccines, most of them tend to be 90 percent or more effective if you receive the recommended dosing schedule, and if need be, the boosters as recommended.”

According to Dr. Dames-Rahming, 100 percent vaccination will never be reached because there are individuals who cannot be vaccinated — people who are receiving chemotherapy like cancer patients; individuals who may be infected with HIV; newborn babies whose systems aren’t working very well; the elderly who are complex individuals with co-morbidities and other things that put them at increased risk; and the people who are just unwell, and their immune systems may be compromised. Vaccinating the people who can be vaccinated, she said, could help protect the at-risk population.

Important schedule
This would mean sticking to a vaccine schedule as set out by countries. There is a vaccine schedule for children and recommendations for vaccinations in adults. Most infants are vaccinated at two months, four months and six months with a variation period when they receive vaccination between their 12th and 18th months. By the time most children are two years of age they would have had about 30 vaccinations — and before they start school they would have received boosters for some of the vaccines they would have needed — diphtheria and polio, measles, mumps and rubella and chicken pox for some areas.

“The schedules may be a little different depending on where you are. The United States Center for Disease Control [CDC] will have its recommendation; the European society will have its recommendation. We have our own schedule that we adhere to as well, so there would be slight differences. There are things that may not be as significant for us. We don’t see yellow fever, so having a routine vaccination for yellow fever is not really relevant to us. It becomes different if we’re going to an area in which it’s endemic then vaccination would be appropriate,” said the doctor.

In The Bahamas, she said, the vaccination schedule has pretty much been the same with a few additions. She said that adults require boosters for measles, mumps and rubella; and that a person over age 30 may not have had a Hepatitis B vaccination and should get one, especially people in high-risk fields, such as the medical profession. In years past, Hepatitis B was not part of the routine schedule. Today, it is standard immunization protocol for a lot of nations.

“Other things that we consider in terms of vaccination would be based on things that we see emerging. Most of us would have had chicken pox as a child. At that time, we did not have vaccination for chicken pox, but now because there can be reactivation, a lot of times for the more mature of us, vaccination for the virus may be appropriate to decrease the number of individuals who may have the secondary reactivation which would be in the form of shingles or Herpes Zoster.”

An unvaccinated population could mean a major outbreak for a disease, she said.

“What immunization does is makes it difficult for disease to spread from person to person. Every society … the Americans, the Europeans, the Scandinavians have demonstrated that there has been a significant decline in the number of cases when vaccination has been implemented. Vaccination does work.”

In nations like Ethiopia, India, Indonesia, Iraq, Nigeria, Pakistan, Philippines, Uganda and South Africa, where more than half of the children are unvaccinated, Dr. Dames-Rahming said there are high numbers of childhood deaths related to pertussis, haemophilus influenza, measles, tetanus — diseases that are preventable. She said statistics show that it costs $6.2 billion in treatment for diseases that a person can be vaccinated against; and that over 25 million lives are affected by disease process. Vaccines she said can actually preserve money, save lives and keep communities healthier.

Immunization controversy
As in the 1800s, there are still challenges on both sides of the vaccination debate with some physicians who are pro, and others who are against; there are also parents who are pro, and those who are against.

Dr. Dames-Rahming said there are the people who believe vaccination is linked to autism, despite the fact that an article that was printed in a medical journal has been discredited, and the research found to be flawed.

“Many of the medical societies and bodies have actually debunked this. There is no clear linkage between autism and vaccination. Despite the fact that there has been numerous studies that looked at thousands of individuals post that particular paper, it sparked such division that there are still individuals who think that there is a link even though there is no scientific proof, and in fact that the way that the research was done was highly flawed, which was the reason why it has not been accepted by any significant medical body,” she said.

She said there are the people who think vaccination contains components that are hazardous to health and as such are against vaccination because they don’t understand the ingredient list.

The doctor said there are also the people who think vaccines are safe and effective, and that basic soap and water decrease the risk of the infections, and as such, that is all that needs to be done.

Then there are those people she called “naturalists”.

“It doesn’t matter that two individuals out of 1,000 may die, it’s still two people who are dying from something that might be preventable. [Naturalists] want us to go back to the time when everything was natural and people only lived until they were 40 or 45,” said the doctor.

The doctor said there are individuals who believe vaccines can cause serious and sometimes fatal side effects; some people think vaccines contain harmful ingredients; and that the government should not be involved in personal medical choices, that mandatory vaccination infringes on religious freedom that vaccines are unnatural and that natural immunity is more effective than vaccination; that the pharmaceutical companies, FDA and CDC should not be trusted to make and regulate safe vaccines; that diseases that vaccines target have essentially disappeared; and that most diseases that vaccines target are relatively harmless in many cases.

Risks and benefits
She said there is nothing that is 100-percent risk free; that medications that physicians prescribe come with their benefits and risk, and herbal medications come with their benefits and their risk.

“Another thing is that they think it carries risk of life-threatening allergic reaction. The truth of the matter is it’s 100 times more likely for you to be struck by lightning than for you to develop a life-threatening reaction to vaccinations. You can have a severe allergic life-threatening reaction to practically anything, so there is a higher chance of somebody having a peanut allergy and having anaphylaxis, which is a life-threatening allergic reaction, than it is for somebody to develop anaphylaxis related to vaccine. So antibiotic, food, additives to different things, bee stings, they all carry a potential risk of their being a life-threatening allergic reaction.”

She said there is also no true evidence or linkage that vaccination may cause neurological and developmental problems, and that there are people who decide not to vaccinate because of what they believe to be harmful ingredients in the vaccines like mercury and aluminium. But Dr. Dames-Rahming said, when present, there

are trace amounts so minute as to be insignificant. She said infants get more aluminum from breast milk and their infant formula than they do from a vaccine; and that all mercury has been removed from vaccines for children under the age of six.

As for whether government should interfere in personal medical choices she said is a “tricky” one for her. She believes individuals are supposed to have their own personal choice about how they govern their bodies and what they have happen to their bodies, but as a medical professional she also looks at the wider picture of having a vaccinated population.

“I think we need to take a step back and understand most of the time that these decisions are made for the greater good — and the greater good is to protect as many of the individuals in a community,” she said.

There are also those people for whom mandatory vaccines infringe upon constitutionally protected religious freedom, as vaccines can contain ingredients some people consider immoral of objectionable. She said a true vegetarian could have issues with anything that is animal in nature being injected into them.

“Some people object because they say it’s unnatural and that natural immunity is more effective than vaccination. Natural immunity is more effective than vaccination, that’s a given — it’s understood,” said Dr. Dames-Rahming. “The real organism will be invading, so there will be a real, more holistic response to that invading organism. However, some of these disease processes come with significant risk when they do happen.”

A person contracting mumps could go deaf; a person contracting measles could get a very bad pneumonia; a person contracting rubella could get neurological issues, and blindness could occur.

“I prefer to be vaccinated, and even if it’s an 80 percent chance that I won’t get the actual disease, I think those are very good odds, as opposed to waiting for a natural immunity which may leave me with disability, or worst-case scenario — death,” she said.

“Prevention is probably the best route to go most of the time. Vaccine-preventable diseases can be dangerous, life-threatening, disfiguring, impair quality of life, or it can be dangerous in terms of sometimes we don’t have a cure and it can actually lead to horrific death like things like tetanus. You don’t ever want to see anyone with a true case of tetanus, it’s like having a continuous seizure — spasming, can’t breathe, muscles are tense, extremely painful, and we don’t have a cure. It’s a horrible way to die. Vaccines are relatively safe. There is no significant evidence to say otherwise that they’re not safe, and vaccination has been proven to be effective.”

Vaccine history
The first vaccine was discovered about 429 BC when a man named Thucydies, who wasn’t a physician, made an astute observation, and noticed that individuals who had small pox who actually survived the disease process didn’t seem to get re-infected, that something fundamentally changed in the individual that made them a little bit resistant to getting a disease process again.

About 900 AD, the Chinese developed a primitive form of immunization known as variolation in which they took tissues or scrapings from the scabs of persons with small pox and introduced it to healthy persons with the thinking that it would prevent them from developing the disease. It seemed to work. For the next several hundreds of years it was practiced. In the 1700s it made its way to Turkey, and eventually to England and ultimately to the United States, or the New World as it was referred to it. They kept on doing it and finding that there were some benefits.

It wasn’t until 80 years later, around 1796 that Edward Jenner discovered the modern form of vaccination. He developed and improved on the vaccination process that was being practiced. It was because of his discovery and modification that the Royal Jennerian Institute was founded, and he was awarded funding for further development of vaccines. As they learnt more over the years, there were improvements with the vaccine, and they developed more vaccine for other disease process.

In the 1870s the first violent opposition to vaccination from a group of individuals who strongly opposed vaccination for a number of different reasons — with one of the prevailing issues being the government made it compulsory for people to be vaccinated. Some people also were not comfortable with vaccinations.

From the 1800s to today there have been two dueling sets of people — those who are for vaccination, and those who are against vaccination. In the 1880s a vaccine against rabies was developed. Rabies is one of those conditions where persons can have neurological changes — they can have seizures, foaming at the mouth. It’s a horrific way to die, and there is no effective treatment. Around 1890, Emil Von Behring discovered the basis of diphtheria and tetanus vaccines.

In the 1920s vaccines became widely available. In 1955 polio vaccination began; 1956 the World Health Organization (WHO) fought to eradicate small pox; by 1980 it was said that small pox had been eradicated from the world; and in 2008, German scientist Haral zur Hausen received the Nobel Prize for discovering that human papilloma virus (HPV) causes cervical cancer. In 2008 they decide to vaccinate girls against the virus. In 2013 vaccinations take place against shingles and the rotavirus, and the rotavirus, a virus that can cause profuse diarrhea and ultimately lead to dehydration. In 2015 vaccinating babies against meningitis B began.

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